850 Long-Term Consequences of Surgery in Patients With Ulcerative Colitis: A Study Using German Claims Data

Abstract

INTRODUCTION: Proctocolectomy in patients with ulcerative colitis (UC) is traditionally considered curative. However, little is known on the long-term complications and costs of surgery in UC and previous literature mostly relied on hospital registry data. Using German claims data, this study explored long-term healthcare resource utilization (HCRU) and costs among UC patients who had surgery and patients who did not. METHODS: Patients from a German health insurance with a UC diagnosis between 01/01/2010-31/12/2017 were included. Patients who had proctocolectomy or colectomy after first UC diagnosis and between 01/07/2010-31/12/2014 were identified and surgery date was set as index. Non-surgery patients were given a random index date in the inclusion period after first UC diagnosis, and were required to have received a corticosteroid or biologic in the six months before index. A 1:2 nearest-neighbor propensity score matching (PSM) with replacement was used and UC-related hospital stays and costs, as well as outpatient visits, were studied in the three years after index. RESULTS: Of 21,392 UC patients, 76 were included in the surgery group (34 proctocolectomy, 37 colectomy, 5 other) and 114 in the non-surgery group. Matched cohorts did not differ significantly in the baseline characteristics and mortality rates where high in both groups (21.1% and 29.0%, respectively). Patients who had surgery relied less on biologics compared to patients who did not (10.5% vs 23.7%, P = 0.022), but the number of UC-related hospitalizations per-patient-year (PPY) was twice as large in the surgery group than in the non-surgery group (0.4 vs 0.2, P < 0.001), and no significant difference in the number of UC-related outpatient visits PPY was observed (7.2 vs 7.0, P = 0.364). This resulted in higher UC-related hospitalization costs for patients who had surgery (cost-ratio = 4.3, 95% CI: 2.0, 6.7). Costs of UC-related medications were lower for patients who had surgery (cost-ratio = 0.2, 95% CI: 0.0, 0.4), but they increased over the follow-up period for patients in the surgery group and approached costs in the non-surgery group. CONCLUSION: While PSM does not account for unobservable confounders and further research on patients who had proctocolectomy is required, this work is the first to study long-term HCRU and costs among UC patients who had surgery and patients who did not, based on claims data. Results show that surgical options may be not curative and result in high hospitalization costs.